America’s homeless services system relies on a massive amount of data, and at first glance, that data is exacting. Federal reports describe the country’s unhoused population in granular detail, listing precisely how many people are experiencing homelessness in each city along with detailed demographic data. Want to know how many people ages 55-64 slept outside in Spokane last year? A spreadsheet confidently provides the answer: ��

That data influences decisions at every level of government, from how the U.S. Department of Housing and Urban Development (HUD) distributes $3 billion in funding to how local service providers target their outreach efforts. It’s also . As a result, communities across the country — including King County — don’t really know exactly how many of their residents are unhoused and have a limited window into people’s circumstances and needs. ��

So, a team of �������� researchers designed a better way to count. Led by , a UW associate professor of sociology, and , professor emeritus of health systems and population health, researchers developed a method that taps into people’s social networks to generate a more representative sample, which they use to estimate the total unhoused population. Along the way, agency staff and volunteers gather information on people’s demographics, resources and needs. ��

The researchers launched this method in partnership with King County in 2022 and repeated the process in 2024, publishing their findings . UW News sat down with Almquist and Hagopian to discuss their new approach and how it could help close the gaps in our understanding of homelessness in America.��

Statistics on homelessness and the demographics of unhoused populations are often quite specific. The federal government reported that on a single night in January 2023, for example. How do we get these statistics, and how reliable are they?����

Amy Hagopian: I’m always a little amused at numbers that create a false specificity; for example, an airline says my flight will arrive in Chicago at 11:33 a.m. Everyone knows that number isn’t true, except sometimes by accident, and yet we entertain the airline by pretending to believe the number. After all, there are no consequences for being wrong!��

The national count is an amalgamation of counts reported by each community’s jurisdiction, designed by the U.S. Department of Housing and Urban Development. Most jurisdictions are still attempting a single-night head count of people found by volunteers who move about in the dark with flashlights and clipboards — a highly problematic approach King County has abandoned in favor of our sampling method. When these numbers come in, HUD just adds them up, and of course the number won’t be round. We all know it’s way below the actual number, because a middle-of-the-night census isn’t going to find everyone.��

Zack Almquist: There is a common fiction that when we do a census it is exact, because government reports often do not provide a margin of error. I think if you asked many experts, they would say they know the reality is a range, not a single number. In fact, not providing a range provides a level of confidence that we really don’t have, regardless of how we get there.

One nice thing about using a statistical estimate is that people are trained to expect a margin of error or confidence interval. We can say, plus or minus 5%, or 100-200 people. In other words, by moving into a space where we expect to see a range, we can be more honest, and ideally be more prepared to handle the real situation.��

Why does it matter how accurate this data is?��

AH: America has the worst homelessness problem in the world created by an economic system – as opposed to war and other disasters – largely because we make no attempt to recognize the human right to housing as established by the United Nations. One reason to count by jurisdiction is to learn where the hot spots are, and which areas have managed to lower their counts, and why. ��

ZA: This is also an equity and respect issue for the people who are experiencing homelessness. We owe it to our community members to do our best to capture the real state of the problem in our area and to best represent their race, ethnicity, gender, disability status, and causal or associated factors like eviction. We cannot hope to adequately engage a problem if we can’t accurately quantify it.

Your team developed a new method to estimate the unhoused population. How does your method work, and how does it differ from the traditional PIT count?����

ZA: Our method takes the approach that there is no reliable way for us to obtain a census of people living unsheltered in our community, and that we need to move from a biased counting exercise to an approach that leverages modern statistical methods to obtain a best estimate of the population given our current resources. Modern sampling methods can improve how we count people. Sampling is the process of selecting a small group from a larger population to study and make conclusions about the entire population.��

We leveraged a sampling strategy that comes out of public health literature and is endorsed by the National Institutes of Health and World Health Organization. First, we collect a roster and bed count from shelters. The HUD-mandated Point-in-Time count was always split between the roster or bed count and an unsheltered count; the latter was historically counted in King County by a visual census. So, the total number of people experiencing homelessness is the number of people in emergency shelters on a given night plus the number of people living outside on a given night. Through some ratios and algebra, we can estimate the total number of people if we know who slept in an emergency shelter and know from historical measures the relative proportion of people who slept outside. ��

Our sampling strategy of leveraging people’s social networks and peer referral allows us to estimate the proportion of people who slept outside to those who slept in an emergency shelter on a given night. Further, this allows us to better find and count people who would be hard to find in the traditional visual census — people living in the woods or hiding — and also provides a clear method for the margin of error of our estimate of the number of people experiencing unsheltered homelessness.��

Your count creates a more reliable estimate of the unhoused population, but that’s not all. What other information can you collect with this method, and how might it be useful?����

AH: When other jurisdictions do their midnight census counts, they are just counting bodies seen. There is no opportunity to collect demographic or life history or health status data unless they shake people awake and interview them in the moment, which few people do. Instead, they conduct a post-count interview process in places like food banks. Our approach provides the opportunity to count people during daylight hours while also learning something about their life course and circumstances. This provides King County with some valuable information about the causes of homelessness. Once we move towards a quarterly count, we can also learn about the “churn” —��the number of people moving into and out of homelessness and what the drivers are for those changes in circumstance.��

ZA: I think this point can’t be emphasized enough, as running a post-count survey is almost always conducted as a spatial convenience sample that surveys both those using emergency shelters and those who slept outside. It’s unlikely to include the same people who were in the one-night body count. ��

What have you heard from people who’ve participated in your method? How do participants’ experiences differ from the old Point-In-Time count?��

AH: We conducted a couple of focus groups recently with people experiencing homelessness in Seattle. We asked them about their impressions of the recent methods change in how we count. We found people appreciated the motivations behind the change, and the more respectful approach we are now using.����

ZA: I just want to second what Amy said, and to point out that people really appreciate being directly engaged with and having a chance to be paid for their time and effort.��

How else could this method be used? Are there potential applications outside of homelessness and housing services?����

AH: I have helped conduct mortality counts in war zones, and some of the lessons learned from those experiences were helpful here. For example, in Iraq conducted a door-to-door survey to ask adult household members to tell us about the alive or dead status of their siblings. This allowed us to calculate a total war-related mortality rate for the country, as our sample was selected proportionate to size of the governorate sampled. ��

ZA: I think the basic ideas used here could end up influencing health and demography measurement efforts for several hard-to-estimate populations. For example, international migration can often be split between those we can count with high fidelity, like registered immigrants, and unregistered immigrants. Combining new sampling methods with administrative data to count hard-to-reach populations could be employed for a number of problems in industry, health and public policy. I hope to see these ideas picked up broadly.��

AH: We are grateful to the UW’s Population Health Initiative for the opportunity to develop these methods, and to our partners at King County Regional Homelessness Authority for being willing to try something new with us.��

For more information or to contact Hagopian and/or Almquist, contact Alden Woods at acwoods@uw.edu.����

Homelessness is a crisis in Washington and��across the U.S.��Last year,����revealed that in King County alone, 11,200 people reported being homeless at the time of the survey. The numbers have only increased during the pandemic.

As one part of its response to this population health crisis, the �������� will welcome back Tent City 3 — an organized tent-city community — on its Seattle campus for 90 days during winter quarter 2021. Move-in is scheduled to begin Dec. 19.

The UW previously hosted Tent City 3 in winter 2017, in the same location it will be next quarter: parking lot W35, situated between John M. Wallace Hall and the Fishery Sciences buildings off Northeast Pacific Street.

“Welcoming back Tent City 3 aligns with UW’s public mission and its commitment to helping solve the challenges of our city, state and world,” said Sally J. Clark, director of regional and community relations. “While organized tent cities are not a solution to homelessness, they do provide safe shelter while people seek out support on the road to stable housing.”

Tent City 3 will provide safe, secure temporary housing for up to 70 people, while at UW. The number reflects a lower density to allow for social distancing and other COVID-19 precautions.

The renewed partnership results from engagement by the����— a group of UW students, alumni and Tent City 3 residents who have been working with faculty, academic departments and local civic leaders to bring Tent City 3 to the UW for a second time.

The UW believes that Tent City 3 remains a valued partner due to its code of conduct and strong reputation for providing a safe and secure home for its residents. Many residents are employed, and many are families with children. For these families, and all of the residents, the tent-city community helps reduce their risk of being crime victims, which is more likely to happen to people experiencing homelessness. Tent City 3 has previously been based in the University District, including across the street from the UW campus, a number of times in recent years.

Tent City 3’s code of conduct bans alcohol, drugs, weapons, violence and open fires. All prospective Tent City residents are checked for sex offender status; individuals on the registry cannot stay. The UW and Seattle Housing and Resource Effort or SHARE, which oversees Tent City 3, have created a new safety, hygiene and security plan and����setting out mutual responsibilities during the hosting period.

“Access to safe and clean places to live, even temporarily, for all Seattle residents is critical to addressing health issues among homeless people,” Clark said. “COVID-19 makes that access even more important.”

Tent City 3 has been successfully implementing measures to maintain social distancing and sanitation standards within the encampment, officials said. In the event of a positive COVID-19 test, Public Health – Seattle & King County is responsible for contact tracing, quarantine and isolation. Tent City 3 will submit a COVID-19 prevention and mitigation plan to the UW by Dec. 1.

The project relies on fundraisers by the Tent City Collective, as well as donations from individuals, student groups and professional organizations. The UW will not use tuition or taxpayer dollars for hosting.

During Tent City 3’s stay in 2017, residents provided lived-experience guidance to UW students and faculty. A����by the School of Public Health found Tent City 3’s 2017 stay was a success thanks to the planning, partnership and generous spirit of encampment residents and UW students, faculty, staff and alumni, Clark said.

In 2017, eight courses incorporated homelessness and housing issues into their curriculums, ranging from English and Environmental Studies to Public Policy and Health Services. Tent City 3’s previous stay also involved service days facilitated by units, professional organizations and student groups across campus, with the support of Tent City 3 residents. These programs included:

• A����to provide oral health care to residents
• The first regularly scheduled����in an encampment
• A 10-week MEDEX course where students learned directly from people experiencing homelessness —����in the nation
• A����and potluck dinner with nursing students
• ��and learning about inequitable access to nutritious food

This year’s academic interactions with Tent City 3 are likely to be held virtually due to the ongoing coronavirus pandemic.

To learn more about this partnership between the UW and Tent City 3, email��regional@uw.edu.

To learn more about the UW’s broader work on homelessness, visit Urban@UW’s��.

The Tent City Collective is organizing volunteers and fundraisers: Visit them on����or email��tentcity@uw.edu.

The presidents of four Seattle-area universities and colleges have joined forces to declare May 13-17, 2019 as Affordable Housing Week on their campuses. Dr. John Mosby, president of Highline College; Dr. Daniel J. Martin, president of Seattle Pacific University; Stephen V. Sundborg, S.J., president of Seattle University; and Dr. Ana Mari Cauce, president of ��������, have signed proclamations or otherwise affirmed the importance of safe, healthy, affordable homes in communities of opportunity. The higher-education institutions join King County and 25 King County cities, including Seattle, in recognizing the benefits of affordable housing to everyone in the community.

To further recognize Affordable Housing Week, local universities are also hosting a first-time conference on their role in addressing homelessness, “Higher Ed on Homelessness: Collaborating for Change,” Friday, May 10 in Seattle. About 75-100 faculty, staff and grad students from more than 10 area higher-ed institutions will share their research, teaching, service learning, community engagement and advocacy best practices. The group will also explore the unique role of higher education in addressing homelessness; define how universities make a difference; highlight what benefits higher education brings to our region and our state on homelessness; and celebrate the accomplishments of students and alumni working to solve homelessness. The conference is hosted by Seattle Pacific University, Seattle University and ��������, and is open by invitation to colleagues at other area universities.

, now in its fourth year, is hosted by the of Seattle-King County. The Seattle City Council is expected to sign this year’s proclamation today, and the King County Council is expected to sign at its meeting tomorrow.

Nationwide, 36 percent of university and 46 percent of community college students are housing insecure; what’s more, 12 percent of community college students and 9 percent of university students are homeless, according to a by Wisconsin HOPE Lab.

Universities are individually recognizing Affordable Housing Week as well. Seattle University’s will host a workshop called “Renters’ Rights 101: Know Your Rights + Assert Your Rights,” Wednesday, May 15, 6:45-8:15 p.m. on campus. Local nonprofits Be:Seattle and Tenants Union of Washington will share what new renters need to know and answer questions. The event is free and open to university students and soon-to-be graduates, and registration is requested.

For more information on Housing Development Consortium and Affordable Housing Week, including a full list of community events:��

Contact:

Seattle University: Catherine Hinrichsen, Project on Family Homelessness, hinrichc@seattleu.edu, 206/398-4457, or Dean Forbes, forbesd@seattleu.edu, 206/296-6114

Highline College: Kari Cantey, kcantey@highline.edu, 206/592-3188
Seattle Pacific University: Tracy Norlen, 206-281-2977, tcnorlen@spu.edu

��������: Victor Balta, balta@uw.edu , 206-543-2580

Housing Development Consortium: Leah Haberman, leah@housingconsortium.org, 206/682-9541

# # #

Rivals in the sports arena, the state’s two largest public universities have teamed up off the field to improve the health of young adults experiencing homelessness – and their pets.

The �������� and Washington State University are working with New Horizons Ministries and Neighborcare Health to provide health care and veterinary care to this vulnerable population. Key educational partners include the UW School of Public Health, WSU’s College of Veterinary Medicine and UW Medicine.

Many people experiencing homelessness have pets, but the animals can be a barrier to health care. Owners may not want to leave their dogs or cats while visiting a clinic. Enter the new One Health Clinic, which welcomes two- and four-legged patients at the same time.

“Our joint human health��and veterinary care model allows us to treat humans and their pets as a unit, since there are so many overlapping health issues,” said Dr. Peter Rabinowitz, director of UW’s . is a professor of environmental & occupational health sciences in the UW School of Public Health, of family medicine in the UW School of Medicine, and of global health, a department jointly run by medicine and public health. “The aim of this project is to determine the best way to integrate human and animal medical care for people facing homelessness and their pets, and to leverage positive aspects of the human animal bond.”

The project grew out of a pilot grant from the UW’s Population Health Initiative. Rabinowitz reached out across the state to enthusiastic colleagues at WSU. The partnership comes amid a statewide campaign by the UW and WSU to promote the affordability and impact of public higher education. In the One Health Clinic, WSU veterinary students work together with UW��medical, nursing and social work��students from University District Street Medicine, a student-run volunteer organization.

“For those people experiencing homelessness, companion animals can provide comfort and friendship. At the One Health Clinic, veterinary and human health students work side by side with their preceptors and community providers to serve these vulnerable animal and human pairs in a truly interprofessional model of care,” said Bryan K. Slinker, dean of the College of Veterinary Medicine.

The One Health Clinic held several pilot clinics last year and is now open up to two nights a month at New Horizons, a shelter and service provider for young adults youth ages 18-25, located in Belltown. Neighborcare Health, which has operated a health clinic for youth and young adults experiencing homelessness since 1993, is the human medical provider at the One Health Clinic. The clinic can serve up to seven client-pairs a night.

“When we can treat a health problem in the pets, we remove that as a stress point while these young people are working to transition from homelessness. This helps them feel safe in accessing care for their own health needs,” said Dr. Katie Kuehl, lead WSU Veterinary Medical Director, One Health Clinic.

One goal of the project is to research the impact that having a companion animal has on the physical and mental health of people facing homelessness and to provide research-based recommendations for combined health care. The Center for One Health Research, based in the UW Department of Environmental & Occupational Health Sciences, explores linkages among humans, animals and their shared environment.

The One Health clinic could eventually expand to Ballard and could include a mobile clinic, but Rabinowitz says sustainable funding is needed.

To learn more or support the One Health Clinic, visit .

###

Turn your head and cough…into the phone?

You may soon hold diagnostic tests in the palm of your hand. Several UW inventors are designing mobile applications that can perform a variety of tests, and then send the results to your physician. One, for example, alerts your physician of orange skin tones in your newborn. This color change can indicate high bilirubin levels. Jaundice in infants is easy to treat, but dangerous if undetected. ��Another app helps people with irritable bowel syndrome track the gut-wrenching effects of certain foods in their diet.

Learn about these and other medical apps being developed at the UW:

��

Anti-craving drug and counseling lower alcohol harm in homeless, without sobriety demands

Chronically homeless, alcohol-dependent individuals might benefit from a new intervention that does not require them to stop or even reduce drinking, according to the results of a preliminary study in Seattle.

Participants in the 12-week pilot program received monthly injections of an anti-craving medication, extended-release naltrexone. They also met regularly with study physicians to set their own goals for treatment and to learn to be safer in their use of alcohol.

“Abstinence-based alcohol treatment has not been effective for or desirable to many homeless people with alcohol dependence ,” said Susan Collins of the UW Department of Psychiatry and Behavioral Sciences. She is the lead researcher on a published report in the journal Substance Abuse.

Read more in HSNewsBeat:

Attention, finally for overlooked elderly with chronic disabilities

American society has lavished attention for decades on the expansive “boomer” population – its dreams, careers, families, habits, midlife crises and now its retirement. Many millions of research dollars have been spent divining strategies for the vast group’s “healthy aging.”

​An important group in this aging generation has been overlooked : those with a long-term physical disability.

A UW rehabilitation medicine expert has received a five-year grant to promote healthy aging among people with long-term neuromuscular problems, specifically multiple sclerosis, muscular dystrophy, spinal cord injury and post-polio syndrome.

See how wellness can be enhanced for older adults with chronic disabilities: